P - 79183' REQUEST FOR ELECTRICAL INSPECTION
��`� J f - 9 8 4❑8 Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
- (651) 642-0800 TfY/MRS 1-800-627-3529 www.electriciry.state.mn.us
NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered hy this request:
XCEL ENERGY SAVER'S SWffCH
401 to
0 to 200 Am e $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes ihe Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SI�NALING Circuits and Two Inspection Trips Each Dwelling Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Insoection Trips (p $20
ALLATION MAY BE ORDERE[
IIII II Ih N III II III II HI II III li III II I� fl II( I I�
1, 7 S 7 9 8 4 8
Fee
TOTALFEE I
(minimum total fee is $20) 20.50
THIS MEA FOR INSPECTOR USE OKY
I hereby certify that I inspecte0 the electrical installa6on describetl herein on the d�es sfaEed:
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neyue:.,� uxne: Rough-in Inspection Required? LJ Yes � No Inspedian Other Than RougMn: �Ttea�1 Now � Wpl Call
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� ��� �0� Vou must call tlie inspector when readyl Date Ready:
I certify that I am tl�e Hl LICENSED CONTRACTOR OCOMPANY ❑ OWNER and hereby request inspection of the elechical work at:
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